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BACKGROUND Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths in the United States. Still, 1 in 3 adults aged 50 years to 75 years have not been screened for CRC. Early detection and management of precancerous or malignant lesions has been shown to improve overall mortality. AIM To determine the most significant facilitators and barriers to CRC screening in an outpatient clinic in rural North Carolina. The results of this study can then be used for quality improvement to increase the rate of patients ages 50 to 75 who are up to date on CRC screening. METHODS This retrospective study examined 2428 patients aged 50 years to 75 years in an outpatient clinic. Patients were up to date on CRC screening if they had fecal occult blood test or fecal immunochemical test in the past one year, Cologuard in the past three years, flexible sigmoidoscopy/virtual colonoscopy in the past five years, or colonoscopy in the past ten years. Data on patient socioeconomic status, comorbid conditions, and other determinants of health compliance were included as covariates. RESULTS Age [odds ratio (OR) = 1.058; P = 0.017], no-show rate percent (OR= 0.962; P < 0.05), patient history of obstructive sleep apnea (OR = 1.875; P = 0.025), compliance with flu vaccinations (OR = 1.673; P < 0.05), compliance with screening mammograms (OR = 2.130; P < 0.05), and compliance with screening pap smears (OR = 2.708; P < 0.05) were important factors in determining whether a patient will receive CRC screening. Race, gender, insurance or employment status, use of blood thinners, family history of CRC, or other comorbid conditions including diabetes, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease were not found to have a statistically significant effect on patient adherence to CRC screening. CONCLUSION Patient age, history of sleep apnea, and compliance with other health maintenance tests were significant facilitators to CRC screening, while no-show rate percent was a significant barrier in our patient population. This study will be of benefit to physicians in addressing and improving the CRC screening rates in our community.

Background We report a rare case of a patient who presented with chest pain and was found to have a constellation of rare cardiac anomalies. Case presentation A 67-year-old patient with no past medical history presented with chest pain. He had mild troponin elevation, but no ischemic changes on ECG. He underwent a CT coronary angiogram for further evaluation. He was found to have a type 0 bicuspid aortic valve, large left sinus of Valsalva aneurysm and type R-III single coronary artery. These findings were confirmed with transesophageal echocardiogram and coronary angiogram. He underwent a successful repair of his aortic root aneurysm with a synthetic patch. Conclusions The combination of type R-III single coronary artery, bicuspid aortic valve, and left sinus of Valsalva aneurysm congenital anomalies in one individual is extremely rare and marks our case unique. Given the size of his Sinus of Valsalva aneurysm, the patient underwent surgical repair of his aneurysm and was asymptomatic when seen in follow-up.

Diabetes remains one of the most common chronic conditions seen in primary care clinics. While it remains one of the toughest quality measures to fulfill, it is crucial since we are approaching “Pay for Performance” in healthcare that will determine physician re-imbursement rates. We therefore performed this initiative to target patients within the internal medicine clinic at East Carolina University, who have a hemoglobin A1c (A1c) >9% (as this is suggested as a quality measure by Medicare’s Merit-based Incentive Payment System and the National Committee of Quality Assurance). The 1st phase involved creating a protocol to identify/contact patients with an A1c >9%. The 2nd phase was to establish a diabetes clinic via a diabetes specialist within the primary care setting with the goal of providing individualized diabetes care for high-risk patients. The 3rd phase was to educate the residents on evidence-based diabetes management through yearly didactic sessions. The 4th phase was to establish a Diabetes Fellow clinic within the primary care clinic. We divided our results according to the level of training of the patients’ primary care provider (attending vs. resident). On Mar 9, 2017, the clinic protocol identifying/calling patients with A1c >9% was initiated, the first diabetes clinic was on Sep 8, 2017, and the first diabetes fellow clinic was on July 30, 2018. Our initiative resulted in a reduction in the number of patients with A1c >9% in the resident clinic (30% vs. 22.6% vs. 20.9% in Feb 2017, Nov 2017, and Dec 2018 respectively) and the attending clinic (24% vs. 19.3% vs. 17.9% in Feb 2017, Nov 2017, and Dec 2018 respectively). Our clinic’s overall number of patients with A1c >9.0% improved from 21.6% in Nov 2017 to 20.02% in Dec 2018. Our project has been successful in reducing the percentage of patients with an A1c >9%. Our project also reflects real-time attempts to improve clinic-wide glycemic control while continuously establishing care with new patients in a primary care clinic. Disclosure B.M. Mishriky: None. J.R. Powell: None. C.E. Holoman: None. M.R. Mian: None.

Both sodium glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase 4 inhibitors (DPP-4i) are effective drugs known to reduce hemoglobin A1c (A1c). While some guidelines favor SGLT2i over DPP-4i, there is no clear criteria in choosing between them. Potentially, baseline A1c could be one distinguishing factor. We performed a meta-analysis to explore the efficacy of SGLT2i compared to DPP-4i according to baseline A1c. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and CINAHL for randomized trials comparing SGLT2i to DPP-4i in type 2 diabetes and reporting a change in A1c stratified by baseline A1c. We pooled trials reporting outcomes based on baseline A1c 9%, we only used outcomes for baseline hemoglobin A1c 9% in the main analysis. Our primary outcome was change in A1c. A subgroup analysis was performed to compare both groups. We included 6 trials. Although there was no significant difference between SGLT2i and DPP-4i when baseline A1c was We conclude that baseline A1c should be considered when considering SGLT2i or DPP-4i. If A1c is ≥8.5%, SGLT2i should be favored over DPP-4i. Disclosure S.O. Page: None. B.M. Mishriky: None. J. Uhrig: None. K. Sewell: None. M.R. Mian: None. J.R. Powell: None. D.M. Cummings: None.